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changing from sustiva
Nov 30, 2005

Hi I'm currently on first line HIV therapy (Sustiva + Truvada) and my docotor wants me to change treatment because of Sustiva CNS side effects that I am finding difficult to tolerate and that are not being controlled by haloperidol, anti depressants and benzodiazepines, and are increasing in intensity. What are my options and would you advise resistance testing and Therapeutic Drug Monitoring to be used in determining my second line therapy? My T cells on starting anti-retroviral therapy 6 weeks ago were 230 and Viral Load 144,000 copies. Presently my T cells stand at 600 and Viral Load is down to 200 copies.

Many thanks in advance - this is a great site for us folks in the UK to benefit from US expertise - cheers

James, London, England

Response from Dr. Young

Thanks for your post. It's great to hear from our readers in the UK.

I'd agree that it appears that you're having a pretty rough go of things-- probably in large part due to the side effects of efavirenz (Sustiva, Stocriin).

Switching shouldn't be too difficult- since you have a rapidly decreasing viral load, there's little reason to suspect either baseline- or treatment-emergent drug resistance. TDM isn't something that we yankees have a lot of experience with, and given that you're still taking your first drug regimen is probably less critical.

If you were my patient, I'd avoid using nevirapine (Viramune) in your case, because with your high CD4 count, you're at greater risk of having liver toxicity.

That leaves us with options from the protease inhibitor side of the menu-- Kaletra comes highly recommended, though newer options (seen most recently in the French treatment guidelines) include the use of first-line boosted fosamprenavir (Telzir, Lexiva). Our patient's experience with the later has been very favorable.

Good luck and good health, let us know how things turn out. BY



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